| NPI | 1801122197 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: ID D-5005-PE) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: TX 25007) |
| Enumeration Date | 2009-10-21 |
| Last Update Date | 2020-05-20 |